Healthcare Provider Details

I. General information

NPI: 1013976612
Provider Name (Legal Business Name): SUJA DEVI DUBOIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUJA DEVI SAVARIRAYAN MD

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 4TH AVE #240
SAN DIEGO CA
92103-2120
US

IV. Provider business mailing address

4060 4TH AVE #240
SAN DIEGO CA
92103-2120
US

V. Phone/Fax

Practice location:
  • Phone: 619-291-6064
  • Fax: 619-291-3078
Mailing address:
  • Phone: 619-291-6064
  • Fax: 619-291-3078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA86651
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: